Diabetes Mellitus 2-3% of the population. The disease can be characterised by five main symptoms,

an inability to reabsorb water, causing increased urine production, excessive thirst, excessive hunger, and a gross fluctuation in weight with a loss of energy. Drowsiness can occur and a feeling of hunger can be so pronounced even after a large meal. There are 2 types of diabetes. Type I and Type II. Type I is insulin dependant. It is the most severe form and can often occur in individuals under the age of 35. Type II is more common affecting 90% of all diagnosed cases, it normally occurs in people who are over forty and are either overweight or obese.

There may be no symptoms at all, in mild cases, but most diabetics are more susceptible to slight infections. The worst symptoms can be loss of sensation (Neuropathy) and inadequate circulation (Ischaemia). There is still a partial ability to secrete insulin and the high glucose levels in the blood can usually be controlled with a combination of diet and drug therapy. This type of diabetes is gradual, but is invariably accentuated by over-eating, drugs or shock. Type II diabetes will tend to have all the symptoms and dangers involved with people who have type I diabetes, but the cases are milder.

Ischaemia can directly attribute to inadequate circulation and tissue oxygenation, poor wound healing, a susceptibility to infection, ulceration and gangrene. Shoe pressure can cause tissue damage. When infection is present in legs and feet this can cause a vasoconstriction which compromises the flow of blood and lymph supply to the area, this can result in infections which can spread. This is a diabetic ulcer and it is slow to heal and amputation cannot be ruled out if not caught early.

Venous ulcers are severe. They usually affect the ankle joint, (malleolus), and is accompanied by significant oedema (swelling). Arterial ulcers are very deep, painful and gangrenous and are normally situated on the foot and the shin.

Regular visits to a chiropodist, to remove callouses, corns, etc is important, as is the general cutting of nails. Your visit will also be an opportunity to have your feet checked thoroughly for foreign bodies or changes in your skin tone and to discuss any problems you may have.

People with diabetes should have their feet examined every year as part of their medical check so that any changes can be noted and advice given about special care. They should be encouraged to give up smoking and to keep their blood glucose levels well controlled and eat a healthy balanced diet. They should take regular exercise. They should protect their feet from extremes of temperature and wear well fitting socks, stockings, tights and shoes. Always check shoes for sharp objects before putting on.

People with diabetes should be encouraged to examine their own feet every day, checking for signs of callus or breaks in the skin. If they cannot do this for themselves they are encouraged to find someone else to do this for them. They are advised to look for anything suspicious such as change in colour of skin, swelling, pus, or any change in movement. They must not treat any problems themselves but to seek help immediately from their G.P. Specialist nurse or chiropodist.